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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Compliance programs - Fraud, abuse, False Claims Act - Medical record retention |
| Topic 2: Reimbursement and Collections | 14% | - Payment posting, adjustments - Accounts receivable management - Refunds, payment plans, write-offs - Patient statements, collections |
| Topic 3: Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Topic 4: Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Topic 5: Claims and Billing | 14% | - Claim submission, tracking, follow-up - Denials, appeals, corrections - Timely filing rules - Electronic claims, clearinghouses |
| Topic 6: Billing Regulations | 13% | - Payer payment policies - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Incident-to billing, global packages |
| Topic 7: Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Medicare, Medigap, Medicaid - Commercial payers - Managed care plans |
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NEW QUESTION # 150
What does AHA stand for?
Answer: A
NEW QUESTION # 151
What does HMO stand for?
Answer: D
NEW QUESTION # 152
The medical word root "hemat" or "hemat/o" refers to:
Answer: A
NEW QUESTION # 153
HSA stands for Health Savings account.
Answer: A
NEW QUESTION # 154
HIPPS stands for Health Insurance Prospective Payment System (code set).
Answer: A
NEW QUESTION # 155
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